Like all Americans, Federal employees who plan to travel for business or personal reasons in the upcoming weeks and months may be understandably concerned. My advice is to visit the State Department and Centers for Disease Control and Prevention’s (CDC) Travelers’ Health websites for the most updated travel information. This CDC website also details preventive measures you can take to protect yourself against Zika if you do plan to travel to one of the affected areas. The locations with ongoing Zika virus transmission are likely to change over time, so be sure to check back to these websites before each trip you are planning to take.

Several years back, the New York Attorney General successfully took up the cudgel against health insurer use of the commonly used out of network fee “reasonable and customary” fee schedule then in use.  According to a Fierce Pharma report, that Attorney General now is tangling with health insurers over Hepatitis C drug coverage. The Attorney General believes that eligibility for the expensive drugs should include members who are in the chronic / asymptomatic as well as the acute / sympotomatic stage of the disease.

Unsurprisingly, the health insurance industry is not pleased about the recent probe. The New York AG’s subpoena “is overly broad and does not take into account evolving guidance related to these new therapeutic classes of drugs,” Leslie Moran, a spokeswoman for the industry group New York Health Plan Association, told the news outlet.  And some of the blame should be placed on drugmakers, rather than insurers, Moran said. The latest investigation “does not take into consideration the impact of excessive and unsupported pricing of these drugs–which has a negative impact on affordability of coverage,” Moran said, as quoted by Bloomberg.

The FEHBlog will be following this fight.

The FEHBlog is interested in genomic developments.  The Wall Street Journal this morning included an interesting opinion piece by two medical specialists titled “Genetics and Mental Illness – Let’s not get carried away.” It’s worth a read.  

Following up on Monday’s post about the final HHS 2017 benefits and payment parameter notice (to be published in the March 8 Federal Register), Prof. Tim Jost published three blog entries — here, here, and here where you can find out everything about this annual monster notice.  For FEHBP purposes, the key aspect of the notice is that the maximum out of pocket limits for group health plans in 2017 will be $7,150 for self only coverage and $14,300 for other than self only coverage. The current limits are $6,850 for self only coverage and $13,700 for other than self only coverage. Most of notice applies to the ACA marketplace plans.

The New York Times reports on the resurgence of HMO plans in the ACA marketplaces. The new HMOs typically feature lower cost sharing, no primary care gatekeeper to limit access to specialists, and a narrow provider network.

[P]atients must sacrifice choice for the promise of lower costs and managed care, whether the plan is called an H.M.O., an A.C.O. or a narrow network. Insurers are able to get low prices for care when they can offer doctors and hospitals a large volume of patients, and providers say they need to have more control over where their patients can get care if they are going to be responsible for costs and the long-term quality of care.

That’s a logical product of the ACA.

OPM’s call letter included several points on Rx benefits, including speciality drugs and medication adherence, Business Insurance lead me to this 2016 Pharmacy Benefit Management Institute Report on  Specialty Drugs (sponsored by Walgreen’s). If you want a copy, you’ll have to register with PBMI.  The FEHBlog nearly fell off his chair when he read on Medpage Today that

Getting physicians to focus on patients’ medication adherence may
result in more patients taking their medicines, but it does not
necessarily lead to improved health outcomes, a small pilot study has
found.

Wow.

Finally, Physicians’ Briefing reports that according to a New England Journal of Medicine study hospital readmissions are down since the ACA began imposing readmission penalties on hospitals. What’s more, “After implementation of the ACA there was no significant correlation between changes in observation-unit stays and readmissions, within hospitals.”

Because leap day gives us an extra workday this year, the FEHBlog decided to offer these quick hits:

• If you don’t feel like reading OPM’s call letter for 2017 benefit and rate proposals (last Friday’s post), you can read this Govexec.com article which hits the highlights. 
• The FEHBlog’s Workshare Comparison program broke when he tried to compare the current summary of benefits and coverage template against the newly proposed template.  It finally dawned on the FEHBlog that he should have checked out Timothy Jost’s blog which does break down the changes here.  
• HHS released a raftload of ACA related rules today. 
• The Dickson blog highlights several popular prescription drugs that will be eligible for generic competion this year. 

Congress will continue to be in session this week on Capitol Hill. The Week in Congress is back in action with an account of recent activities up there.  Drilling down a little, here’s a link to a Federal Times article about the House Oversight and Government Reform Committee hearing about the Obama Administration’s efforts to tighten security around goverment background check records. There’s a discussion of the Anthem data breach at the end of the article. The irony there of course is that the same Chinese hackers struck OPM and Anthem.

The ACA regulators, as promised, released a revised draft version of the summary of benefits and coverage that health plans must provide to their customers.  The ACA regulators expect health plans to use the new version in their next open season once it is finalized.  The FEHBlog noticed that the ACA regulators added another coverage example (a simple fracture) and made some happy to glad word changes. One wonders whether it’s worth the effort. The FEHBlog still does not understand why the law does not require health care providers to disclose the networks in which they participate to their patients.  The ACAburden always falls on the health plans.

The FEHBlog noticed a television advertisement today announcing that M&M candies will celebrate their 75th anniversary tomorrow. HIPAA will celebrate its 20th anniversary of its passage into law this September. Last week the HHS Office for Civil Rights which enforces the HIPAA Privacy and Security Rules took a couple of actions discussed in this Fierce Health IT article.

HIPAA required HHS to adopt a patient identifier. Congress blocked funding for that initiative soon after enactment.  Healthcare Informatics offers thoughts and recommendations on the adoption of a patient safety identifier. Healthcare Data Management suggests that new credit card technology may save the day.  Some sort of patient identifier would simplify matters.

Health Grades issued its annual list of top 100 hospitals last week.  No hospital in the Washington DC metro area made the list.

The FEHBP year, just life the NFL year begins in March. The beginning of a new FEHBP year is signaled by OPM ‘s issues of the “call letter” for benefit and rate proposals. OPM issued the 2017 call letter this afternoon. OPM will be issuing technical guidance for carriers that builds on the call letter. The benefit and rate proposals must be submitted by May 31, 2016.

Yesterday, according to the Washington Post, OPM’s embattled Chief Information Officer Donna Seymour retired from the federal government rather than serve as the star witness before the House Oversight and Government Reform Committee’s third OPM data breach hearing. The Committee cancelled the hearing which had been scheduled for tomorrow morning. “No timeline was announced for Seymour’s replacement.”

It is gratifying to the FEHBlog that the Federal Times agrees with his interpretation of the federal court ruling upon which the now retired OPM Inspector General challenged the validity of the OPM acting director’s actions since she was nominated to be permanent director last November 10. Tempest in a teapot.

Last week the FEHBlog noted that AHIP and CMS had reached consensus on quality measures to be applied to health care providers. Fierce Health Payer offers an interesting interview with Andrew Baskin, M.D., Aetna’s national medical director for quality performance, who was part of this important collaboration. Dr. Baskin credits an innovative approach to achieving consensus and a new emphasis on value based payments for this achievement. Bravo.

Here are a couple of prescription cost tidbits:

• CVS Health today announced that “prescription drug trend, a measure of growth in prescription spending, for CVS Health pharmacy benefit management (PBM) clients dropped dramatically to 5 percent in 2015 from a high of 11.8 percent in 2014.”
• The Wall Street Journal interviewed Merck’s CEO Kenneth Frazier about “big Pharma’s delicate dance on drug pricing.”   

On the cybersecurity problems front, CBS News reports that a Los Angeles hospital paid hackers $17,000 in Bitcoin ransom to unlock its unlawfully encrypted Thelectronic medical records system.

CBS News correspondent Carter Evans reports that according to a source familiar with the investigation, the hospital paid the ransom before contacting law enforcement. “If they decided to pay the ransom, it probably means that they didn’t have very good backups, they weren’t able to recover the data, and that the data would have been lost if they didn’t pay the ransom,” Dave Kennedy, CEO of the information security firm TrustedSec, told CBS News.

A report from Intel Corp.’s McAfee Labs released in November said the number of ransomware attacks is expected to grow even more in 2016 because of increased sophistication in the software used to do it. The company estimates that on average, 3 percent of users with infected machines pay a ransom.

The Washington Post reports at length this morning on efforts to treat the causes rather than the symptoms of mental illness.

The[se] efforts have been bolstered by advances in technology and imaging that now allow scientists not only to see deeper into the brain, but also to study single brain cells to determine which circuits and neurons underlie specific mental and emotional states. Many of these advances come from fields as disparate as physics and electrical engineering — as well as the new field of optogenetics, which uses light to manipulate neurons.

Best of luck.

Finally the Wall Street Journal reported last week on the cash economy for healthcare which exists beside insurance coverage. Oddly enough, before the Affordable Care Act, hospitals charged their highest rates to the uninsured. Now that health insurance is mandated, hospitals and other providers are willing to negotiate services like MRIs for cash.  Go figure. Not suprisingly, some of the change was encouraged by the zany ACA itself, and of course there’s a website for those who want to pay cash for their surgical procedure.  

The OPM Inspector General-triggered controversy over the legality of the acting OPM Director’s service since she was nominated to be permanent director continues to simmer.  The Washington Post reports that Ms. Cobert is not the only acting agency leader in the soup. The FEHBlog took the time last night to read the 28 page D.C. Circuit opinion (SW General, Inc. v. NLRB) upon which the Inspector General relies.  At the end of the opinion, the Court “emphasized” the “narrowness of our decision.” “[W]e do not expect it to undermine a host of NLRB decisions.” A party must have standing to and must actually bring a lawsuit challenging the validity of the acting agency leader’s decision in Court based on the Federal Vacancy Reform Act in order to upend any particular action.  It appears to the FEHBlog to be a tempest in a teapot.  The OPM IG retires today.

OPM now has posted its FY 2017 Congressional Budget Justification.  Fun reading for the weekend.  The budget justification discusses OPM’s FEHBP claims data warehouse.  The FEHBlog is not suggesting that there is any connection but the Wall Street Journal reported the other day that

Employee wellness firms and insurers are working with companies to mine data about the prescription drugs workers use, how they shop and even whether they vote, to predict their individual health needs and recommend treatments.

Trying to stem rising health-care costs, some companies, including retailer Wal-Mart Stores Inc., are paying firms like Castlight Healthcare Inc. to collect and crunch employee data to identify, for example, which workers are at risk for diabetes, and target them with personalized messages nudging them toward a doctor or services such as weight-loss programs.

Companies say the goal is to get employees to improve their own health as a way to cut corporate health-care bills.

Privacy advocates have raised concerns about such practices.

That’s a bridge too far in the FEHBlog’s view.

Here’s a link to an interesting Fierce Healthcare article about a Highmark subsidiary that helps hospitals cut costs on major medical device purchases. Bravo.

The OPM Inspector General’s retirement date is this coming Friday and he has thrown a grenade as he walks out the door.  The Washington Post is reporting today that the Inspector General has advised OPM Acting Director Beth Cobert that federal law required her to step down as acting director when the President nominated her as permanent director on November 10, 2015. According to the Inspector General’s letter, all of Ms. Cobert’s official actions since that date are null and void and cannot be ratified. The Post reports that

White House spokesman Frank Benenati said that Cobert was named acting director “consistent with the Federal Vacancies Reform Act. Since 1999, presidents of both parties have relied upon the consistent guidance and interpretation of that act by the Department of Justice governing when individuals may serve in an acting capacity while their nominations are pending before the Senate, and the Administration continues to rely upon that guidance. We firmly believe that Acting Director Cobert is acting within the confines of the law,” he said in an email.

The FEHBlog does not see this dispute going anywhere. It’s an oddity.

Yesterday, the Centers for Medicare and Medicaid Services announced that the agency in collaboration with health insurers and providers and the National Quality Forum has developed seven sets of quality standards which public and private payers will apply uniformly to providers.  “In the U.S. Health care system, where we are moving to measure and pay for quality, patients and care providers deserve a uniform approach to measure quality,” said CMS Acting Administrator Andy Slavitt. “This agreement today will reduce unnecessary burden for physicians and accelerate the country’s movement to better quality.”

The Healthcare Leadership Council announced six steps toward more effective, patient centric healthcare according to Fierce Healthcare report. Here are the first two which the FEHBlog certainly supports —

• Set a “firm date”–Dec. 31, 2018–to achieve health information interoperability everywhere in the U.S., with the private sector leading the way to help healthcare organizations share data. This parallels the goal set forth by the Medicare Access and CHIP Reauthorization Act (MACRA), the report notes.
• Implement reforms to improve the Food and Drug Administration, including easing administrative burdens imposed on the agency and taking steps to more quickly deliver innovative treatments and technologies to patients. 

The FEHBlog looks at Twitter in connection with sporting and political events. Consequently, when UConn was playing men’s basketball yesterday, he took a look at Twitter and there was the first report of Justice Scalia’s death. It took about 30 – 45 minutes (following the Texas Governor’s announcement) for the reports to appear in the AP, etc (understandably).  Very sad news.  Here’s a Politico link to various legal scholar’s viewpoints on this service on the Supreme Court.

Congress is not in town this week. Its sessions resume next week.

OPM posted about the cybersecurity aspects of the President’s budget.  OPM has not yet posted its budget justification to Congress. The next piece of the puzzle will be the Congressional Budget Office’s estimates of the costs and savings produced by the budget. That publication will be released in March. 

The Hill reports on the progress that is being made to shift the Medicare Part B reimbursement system from a fee for service to a value basis. Congress has allowed five years to complete this process. However, 

While hospitals have been shifting toward alternative payment models
under the Affordable Care Act, it will be new for physicians. There
are some concerns that a five-year window is not enough time for the
national healthcare system to shift into a new delivery model. Some
groups are already calling for a delay of the rule.